Welcome back to this weekly meeting of the Health and Safety Committee with Denver City Council.

Coverage of the Health and Safety Committee starts now.

Good morning.

This is Wednesday, August 20th.

I had to check to see what day was.

Um it's um this is a health and safety committee.

My name is Daryl Watts, and I'm honored to serve as a city council member representing all of the flying district nine.

Um, we have a uh a brief but powerful uh briefing uh meetings today on health and safety.

We have two briefings and then uh four consent items before we go into the presentations.

Let me turn it over to the city council members uh to introduce themselves and we'll start on the run.

Uh good morning everyone, Kevin Flynn, Southwest Denver's District 2.

Hi everybody, Sedana Gonzalez, one of your council members at large.

Good morning, Diana Romero Campbell, Southeast Denver District 4.

Good morning, Paul Cashman, South Denver District 6.

Jamie Torres, West Denver District 3.

Good morning, everyone.

I believe that council member Perry is joining us virtually.

I just wanted to check in to see if the council member is online.

Doesn't appear that she's on, so why don't I turn it over to our briefings?

And once council member comes, we'll announce her.

We have two briefings.

First, Denver Health Housing Outreach Partnerships and Engagement.

I turn it over to Stephanie and team.

Please introduce yourselves and then uh the floor is yours.

Um good morning, everyone.

Um, thank you to Councilman uh Watson and the entire um council for allowing us to come and share about our work today.

My name is Dr.

Sarah Stella.

I am an internal medicine physician and hospitalist um at Denver Health where I practiced for the last uh 18 years in the inpatient setting.

Um, and we are excited to share with you about our how Denver Health partners to address homelessness today.

I'm gonna let my co-presenters and colleagues introduce themselves.

My name is Mara Prandy Abrams.

I'm the operations manager of patient flow and the co-director of our hope program.

Hello, uh, my name is Tom Gray.

I'm a project coordinator at Denver Health, sitting within the Office of Research and uh coordinator on this uh this hope team.

Um so I just want to start first by telling a story.

So um at Denver Health, our patients are our reason for being, our reason for existing.

Um, and taking care of um our patients has been um such a pleasure.

They've given me so much more than um I've given them.

I want to tell you about a patient uh today named Mr.

D.

It's a patient that I took care of a couple times over the course of the past year, who um illustrates for me why I uh work on this intersection of housing and health, and the importance of Denver Health as an access point for um housing and other supports in Denver's homelessness response system and the value of partnerships.

So, Mr.

D was a gentleman, he was in his mid-50s, um, has um poorly controlled diabetes, has been living um unsheltered for about the past five years.

Uh, two of those years with uh a cane and then a walker uh and finally a wheelchair.

Um and so Mr.

D was had multiple admissions to Denver Health over the past year for limb-threatening infections requiring amputations.

Um, and I saw him on two of those visits, and over time he was just getting more and more um frail as he was losing um parts of his foot and ultimately his his leg.

Um, I use this case because it also uh he was also someone that had a lot of challenges with accessing um homeless services in the traditional way.

So he had a lot of difficulty with um being able to um access uh congregate shelters.

Um, he also had significant barriers, and um to be able to access subacute rehabilitation, which um would have been appropriate after surgery, but was not covered by Medicaid.

Um, this patient um I was examining him one day.

He had an ulceration on the bottom of his foot, which had progressed to bone.

He um I asked him while I was examining him: hey, are you working with anybody um on housing?

Do you have any prospects for housing?

And he said, he looked at me and he just said simply, Doc, I just keep falling through the cracks.

And that for me is why I do this work and why we all are here today.

And so when patients like Mr.

D fall through the cracks, Denver Health is there to catch them.

And in 2024 alone, we cared for 16,000 patients who collectively had almost 80,000 visits across our integrated health system.

So we are disproportionately impacted by this challenge.

And actually, we'll go back to that slide.

And we also see a group of folks, especially in the hospital, who are more likely to be unconnected.

And so they might be coming to the hospital or the emergency department frequently, and often they are not engaged with other homelessness resolution partners in the community.

So as the social worker colleague said, we see a group of folks that never darken the doors of a homeless service agency, and I think that's important.

We know that homelessness drives avoidable health care utilization.

And so the data that you see here on the left, this is a pie chart looking at our highest utilizers of Denver Health's emergency department.

So we these are folks that have had 19 plus emergency departments in the past year.

So these are folks that are coming that are well known to us that are frequently coming to the emergency department often because they don't have shelter or other needs are not able to be met.

You can see in the yellow there that 66% of this group of uh high utilizers of emergency department services were experiencing homelessness.

So a substantial portion of those patients.

On the right, we see a similar chart looking at the top highest inpatient hospital utilizers.

This is our adult and critical care and psych patients, again, one year's worth of data, and these are folks that have been had significant challenges with readmission.

So they've been readmitted to the hospital seven or more times in the past year, often due to their housing stability presenting destabilization of their health.

And 30% of that group is experiencing homelessness in the past year.

We know that when patients because patients experiencing homelessness come to the hospital sicker, their care is often delayed, and then they also stay longer in the hospital because of that, and because sometimes finding them a place to discharge to that is safe and appropriate is so challenging.

So you can see on the left here, this is looking at our average inpatient length of stay for our homeless uh patients versus our not homeless patients.

So you can see that individuals that are unhoused stay almost two and a half days longer on average than the general population.

And they are also substantially more likely to be re-hospitalized within 30 days compared to our house patients.

And this is why this has a great impact on health outcomes for my patients.

It also has an impact on Denver Health's ability, our hospital capacity and our ability to serve our patients.

And so we've been focused over the last eight years on really building connective tissue for effective housing and health partnerships.

And this is sort of a timeline of our partnership development work.

Some of the partners you can see are listed above, but back in 2018, we partnered with the Colorado Coalition.

We conducted joint community partnered research to better understand the opportunities and priorities to improve care.

We've done joint strategic planning to improve care for our large shared homeless population.

During the 2020 and 21, we worked on the we worked with the city to execute the homelessness or the pandemic response, providing vaccines, and testing and shelter settings.

We have also partnered with healthcare policy and finance on housing pilot for Denver Health Medicaid patients.

And then as you can see, we've been building this work over time.

We've invested in transitional housing at our 655 Broadway property, as well as investing in recuperative care at the Colorado Coalition for the Homeless.

And then that is all leading up to the work that we're going to share more about with you today.

And all of this work has really informed the model of connection that we are working on from within acute care.

So I'm gonna let Tom now kind of tell you more about that model.

Sure.

So yeah, I'd love to share more about this model that we have for connecting patients to housing.

Really what we're thinking about here is using that episode of hospitalization as an opportunity for us to connect those patients that Dr.

Stella said, you know, might be very disconnected from other traditional homeless service providers back into care or refer them to the right place.

So first of all, we're able to use the right data to identify folks.

So what this looks like is us being able to leverage our electronic health records to be able to build reports, create notifications, and other systems for identifying folks that might have a housing opportunity, might be prioritized for different resources, so we can locate them in our system.

The next step is for us to outreach.

So we have the right team to be able to go and coordinate with those care teams to engage the patients there and to uh to assist with you know that that connection.

And then last we have the right partners that we can connect to.

So this includes a lot of the groups below, but in that um in that episode of hospitalization, um, we're you know trying to create a warm handoff whenever possible, trying to get that person to the service that's gonna be able to benefit them most.

In many cases, that's uh permanent supportive housing through some of these uh these partner organizations.

We've been able to expand that um this model and recreate it with our um our CIPRA housing to health program.

We've also been able to do it with our state uh statewide supportive housing expansion project, our current housing outreach partnership engagement team, as well as with the city's roads to recovery program.

So I want to share a little bit about you know what this tends to be looks like uh for the patients.

Um a patient example, the patient names have been changed.

Um but Joel arrived in the emergency department due to complication of his unmanaged type one diabetes and a history of stimulant use disorder.

He was on a priority list for the roads recovery program, and the Denver Health Pro Denver Health Hope Team was able to get a notification and outreach him while in care.

We outreached him, attained consent, and arranged for a city case manager to come meet him in the hospital, enroll him in that program, and then he was able to enter housing following discharge.

When I was talking to Joel, and when we um you know uh I finished introducing this program, um, he told me that he was ready to accept help and get his life on track.

Um, somebody that a lot of other interventions hadn't worked for in the past.

And then a few uh testimonials or quotes from uh other folks that we've worked adjacent to.

Um, this first one is from a supportive housing staff member on the the CIPRA housing to health program.

Um they said it was really hard when if we located someone and we couldn't get them into bridge housing, sometimes they would go back to the streets and just be a leaf in the wind.

But then we'd get a call from Denver Health.

Um, what we heard from that program is that the connections that that we made directly into that program uh were often uh you know much much more solid.

It created an opportunity for some stability when just that outreach work was touch and go sometimes.

And this second one is from a Denver Health physician saying it's hard to describe how grateful and aesthetic he was about his housing connection, and that joy was contagious.

We regularly took a moment for a brief hooray during rounds and the days leading up to his discharge.

We gave him a big high five on the day of discharge.

Um I think that this just celebrates what it can feel like and how different it can feel when we're able to actually provide uh solutions to people exiting the hospital rather than you know continuously having them in a cycle of going back to the streets and re-hospitalization.

Um, and these are some of our latest investments.

So, as I previously mentioned, Denver Health invests in these strategies, including transitional care as well as recuperative care through our partnerships with the Denver Housing Authority and the Colorado Coalition for the Homeless.

And this is really to serve some of our most vulnerable patients, because it's better for us to invest in these things which are better for patients and also more uh cost effective than to house people in a hospital, which is the most expensive and least appropriate place to house someone.

Um we have 14 units at 655 Broadway.

That's the office building that we sold to the housing authority that's located on our hospital campus.

Um, and we have 14 units for elderly and disabled patients who are exiting the inpatient setting.

Um we've had um about, I'll tell you some more about the outcomes for that, but um we've been successful in transitioning um most of the folks that have gone into that program into more permanent housing.

We also have a strong partnership with the coalition to improve care transitions, and this includes an investment in their recuperative care facility.

So Denver Health leases 20 beds, which is more than any other hospital, uh, as a discharge destination for our many of our complex folks that need wound care, IV antibiotics.

Um they've a broken bone, they need to stay up their feet so they can transition directly from the hospital into recuperative care and have a safe, stable place to recover as well as get connected with um with services that ultimately are gonna help them exit homelessness, hopefully.

Um, and we have had some positive results for um through collectively through all of this these programs and this work.

So since the recuperative care center opened um in February 2023, we've discharged over 700 patients, not back to the streets but back to but into the recuperative care center where they can stay for weeks to in some cases months, um which is really important for their recovery, their connection, and for not needing to come back to the hospital.

Um we also have housed 34 patients to date at our 655 Broadway uh property through our partnership with the Denver Housing Authority, 22 of whom have been connected to longer-term housing either through a permanent supportive housing or a Section 8 voucher, or through family reunication reunification or a higher level of care.

Um 70 patients we have connected a total of 120 times to the CIPRA housing to health program.

So these are folks that come in and are very surprised to learn that they are eligible for housing, that we connect through a warm handoff, like Tom mentioned, and in many cases they go directly into bridge housing.

So that's kind of the initial connection, and then we reconnect a large number of folks as well to that program.

Um maybe that was that patient was uh found by an outreach team, started on the housing paperwork, got lost, wound up at Denver Health.

And then we've connected a number of other patients to other voucher programs, including the statewide supportive housing expansion.

So we're gonna shift gears a little bit and tell you more about our housing outreach partnerships and engagement program.

As you recall, this is funded by a generous grant from the Denver Department of Public Health and the Environment.

Those two years of funding, and we're now entering our second year.

The goal of this funding is to use the lessons learned from all of that preliminary work and really apply this housing model and improve upon it and really build our partnerships because this is all this work is all about partnerships.

We can only connect people, patients to housing that exists, and partnerships are the most important thing.

So we're really working to build those partnerships.

Outputs outputs of this work.

So we utilize internal and external data tools, including the region's homeless management information system, to understand folks' connectedness with homeless service providers, and we're reaching out to those providers to help us coordinate care and improve access to housing and other supports.

So we've served about over 200 patients to date, where we've provided housing focused screening and case management, and for a subset of those, an active warm handoff to a community partner that can continue to work with this person on housing once they leave our care.

So all of this work has been really good in terms of Denver Health and our ability to serve lots of patients.

So this chart, there's a blue line that's kind of down to the right.

That's our length of stay index.

So that compares how long a patient stayed in a hospital compared to how long they should have stayed.

And then the gray line that unfortunately is going up and to the right is the number of individuals we've served who are experiencing homelessness.

So ultimately, while we've seen that incredible increase, had we not done all this work and decreased that overall length of stay, our hospital would be full all the time.

And what's pretty incredible about all of this is even while we're decreasing that length of stay overall, we've not seen an increase in the overall readmission rate for this population, which has been incredibly beneficial.

We recently have partnered with host to do some data analysis within our system as well.

And so we've looked at individuals experiencing homelessness who are discharging from the hospital, so these are inpatient encounters, to look at their overall sort of functional needs.

And so of 2,218 total encounters, which is about 1,500 unique patients, about 59% of those have some kind of functional impairment that really prevents them from being able to discharge to a traditional congregate shelter.

So that could be cognitive impairments, mobility impairments, or sort of chronic oxygen needs.

And so this is a real big struggle because ultimately a lot of those individuals cannot go to a traditional congregate shelter environment.

So if we look at this is a chart of really level of care is that x-axis, and then the y-axis is our medical and behavioral health complexity needs.

This sort of shows where people's needs could be met in terms of the different levels of care.

So all the way from sort of the lower left, that tent or outside congregate shelter, and then sort of moving up to the right, you know, micro-communities, non-congregate shelter, permanent supportive housing, all the way up to skilled nursing, and then ultimately there's that little dotted line that says really under that is a level where someone could live independently.

If we go to the next slide, you can see those things in blue.

So short-term medical respite, microcommunities, non-congregate shelters, and permanent supportive housing are really the things that are most limited in terms of capacity.

And the long-term medical respite doesn't even exist right now.

Um, so ultimately, there's, you know, you're seeing more of a shift if we go to this next one.

The folks that we talked about with those uh impairments, functional and cognitive impairments are ultimately mostly living outside, because a lot of them, that's really a barrier for them to access those traditional congregate shelters.

And so we're seeing is the most vulnerable are really living in an environment that's really not suited for their needs.

So for the takeaways, really, we think Denver Health has an important role to play in this homeless response system, particularly for those folks that we just talked about that have those medical and behavioral uh complexities.

Ultimately, many of the patients, as Dr.

Stella mentioned, that we see are very, very vulnerable, and so they're not engaging with community partners, but they are coming to Denver Health.

And then we think improved methods of data sharing are really needed to improve that timely outreach and enable those housing providers' participation in that care coordination.

So all of this really ultimately needs funding to be able to be sustainable.

Our current investments is Denver Health.

We uh those recuperative care beds that uh Dr.

Stella mentioned, we're spending $864,000 a year for those.

The 655 Broadway lease of those 14 units is about 150,000 a year.

And then the Hope team between the grant and then our own investments, it's about $800,000 a year.

Uh but on the flip side, when we look at those uh excess days, where we talked about that average of about two and a half days uh that those homeless individuals spend in the hospital in 2024, that cost us about 8.4 million dollars.

So all these investments, if we had not been putting them in, ultimately that number would be significantly higher.

Um, and so really we think that Denver Health is positioned to be a critical partner in the city's housing response uh and resolution.

Any questions?

Uh I tell you all, I I needed some good news today.

And even though you uh made me cry throughout the whole presentation, um really thank you all.

It's been emotional we got, I'm just dealing with emotions, but really thank you.

Uh Dr.

Stella, thank you.

Uh Brandy, and uh thank you, Thomas Gray, and your entire teams.

I know my family's not the only family who wish this type of service was available for a loved one that they lost living homeless on the streets when medical um support was needed, and once they got to medical care, they went right back on the streets and uh my sister died from her medical conditions um living in an abandoned structure.

So these tears are happy tears because I know that other families are receiving your support.

I do have questions, but uh, we do have a cue, and so I will go to the queue first.

Councilmember Flynn, Councilmember Torres, and then Councilman Cash.

Thank you, Mr.

Trevor.

Thank you, Dr.

Snow.

I had a question, just to do a little deeper dive on the slide for the pie charts there.

Um, with all the numbers that you've talked about in the whole program and in ER and whatnot, I was a little bit surprised that the whole number of individuals represented in those charts is 51 on the left and 46 on the right.

And maybe that's because it's limited.

Well, on the right is you've had seven plus inpatient discharges in the one year, so that accounts for a smaller number.

Uh but what I'm mostly curious about is what do you think?

Do you have any idea what accounts for the difference in homeless versus not homeless?

Uh, particularly in those who are inpatient.

More individuals who are homeless are visiting the ER, I suppose.

But it seems like a it's it almost flipped exactly.

Yeah.

One-third, two-thirds when it comes to inpatient.

Yeah.

Any idea what accounts for?

Yeah, so that's a great question, actually.

And something that actually surprised us when we looked first started looking at this and tracking this a number of years ago.

So the numbers, as you pointed out, are smaller because we just took like the highest utilizing people who are having very, very frequent encounters.

So for to give you a frame of reference, if someone comes to the ER more than five times, that is what we call a superutilizer.

These folks that we're talking about that are visiting the ER, they're often coming multiple times a week.

And a lot of times that is due to lack of because they're not getting their needs met for shelter.

Um, and they have a lot of barriers to going into a shelter and using traditional shelters.

And so they're coming to the emergency department because they do not have shelter.

We also see the same thing at Denver CARES, folks using that as shelter.

And sometimes they'll even tell you that they're they're there seeking shelter.

There isn't as another the other part of your question, which is also great, is that there isn't as much overlap as you might think between our inpatient high utilizers who are tend to be more medically acute and medically complex and have a reason to admit them to the hospital.

And not to say that our folks that are visiting the ER are not complex in other ways, but they aren't as complex, thus they're not getting as admitted as frequently.

Are some of the 51 in the ER also among the 46 among the inpatients?

Is that possible also?

It is possible, but not typically.

Okay.

Um an individual who is homeless comes into the ER, you said a lot of that has to do with uh what was it you said that?

Seeking shelter, not having their um survival needs met often.

Are they coming in with their own health conditions that are untreated, or are they coming in because of physical injuries sustained living on the street?

I think it's a major distinction between.

Yeah, that's it's really a combination.

We see all of those things.

Um, yes, people are patients have very high rates of violence and victimization, and so we do see a lot of uh violent um violence um and injuries, assaults, um, motor vehicle accidents, things like that.

Um, we also see a lot of folks who maybe um were using fentanyl, overdosed, come in, get treated, and then don't want to stay with us.

We try to encourage them, we try to get them engaged through our treatment and demand um team if they do not want to stay, but they are highly vulnerable.

So we really see a combination of all of those things.

Thank you.

That gives me a little better picture of the why I saw the differences in the two.

Yeah, appreciate it.

Thank you, Mr.

Chairman.

Thank you, Councilmember Land Council Member Torres.

Thank you, Mr.

Chair.

Um, thanks everyone.

Uh one of the things that I think is really important for me to understand a little more is the coordination with the city programs.

So you mentioned roads to recovery.

Um it's so nascent.

I think I'm also trying to understand who and how they partner with other like basic needs and critical care resources.

Um, just from the year or so that you've been working with roads to recovery or any other kind of major city program or initiative, what needs to be improved?

Yeah, um, thank you.

And um, Erin is also here, um or was here.

She's coming in, yeah.

Great.

Um, so um, yeah, so we've had the opportunity to work um really closely with um Aaron and the Roads to Recovery team through this uh grant.

Um we meet with them on a biweekly basis, actually.

Um, and a lot of what we've done so far, so we've done um some data analysis at their request to help better understand the needs of the people that they're attempting to serve.

We looked at their health care utilization patterns at Denver Health.

Um, and then we've been working um collaborative processes to think about what is that, what is that connection look like?

I think some of the challenges, um, and Aaron can also speak to this, um, that there's challenges with this work with a population whose care is so fragmented across multiple health and social service providers.

Um, data sharing is a really big um challenge that I think both of us um are uh encountering.

Um, and you know, we need a release of information to be able to have that per patient's permission to connect them to the roads to recovery team for care.

Um we have pretty good success with that.

So we do we the way we work is very similar to how we make these connections for the CIPRA program.

So it's rare that people say no.

They don't want a connection with that program, but we're just we've been really focused on workflow, and now we're piloting some cases together with a connection.

So I'd say data sharing is like the biggest challenge.

I think, you know, there are patients that I think also may come in, um, are using a lot of substances.

The roads to recovery team wants to send them in, um, and then they don't get admitted because they become sober.

So we're working with our psychiatric emergency uh department on like what more does what does that look like for for that group of uh folks that they are wanting to send to Denver Health for evaluation.

Okay, thank you.

I'll be interested in how that can constantly be improved and where other barriers exist.

Um, because I think that we'll get thrown a variety of different curveballs over the next year or so when it comes to serving this population.

Um for 655 Broadway and Stout Street, how long is transitional for the Denver Health leased beds?

How long are people in the beds?

Um, yeah, so for uh our recuperative care beds, um, those are shorter terms.

They're not housing, but they do provide um uh stability for many of our folks.

Um so that people are staying about two to four weeks on average, although in some cases they're staying longer.

So we have a very nice um collaborative standard worker process with the coalition to get people safely there, and then we actively manage our recuperative care beds in partnership with the recuperative care center through our care management team on a weekly basis.

We're reviewing who's in our beds, and if they have indications um, you know, they're non-weight bearing or their wound is getting worse.

We'll in some cases grant extensions, however, as I mentioned, we're only able to do that when we have capacity and the demand on these services far outstrips the supply.

Um, and so in the winter, you know, we we have a lot less um flexibility to be able to do that because we have to be innovative that you have that, and I really commend Denver Health for um kind of creeping into that space of um housing and transitional care.

So thank you for that.

Um just a last quick um question on outreach and engagement.

Um, one of the things that came up frequently when Denver Health was our partner for the safe outdoor space in Law Lincoln Park was the relationship with the neighborhood because of discharges.

And you mentioned earlier you can't force people to stay.

Um, you can't force people to accept help.

Um, so they will just leave the doors of the emergency room or or wherever.

Um, what's what does Denver engage um deeply with Lama Lincoln Park, Baker, Spear neighborhoods who might see some of that population flow back out into um uh into the neighborhoods?

Yeah.

Yeah, so we are intentionally meaning um actually Broadway merchants has come to us and says, um, what resources can we utilize if we see an individual who is struggling or having an episode?

And so we're actually gonna be doing a presentation with them mid-September with our mobile crisis unit with our star team so that they know what and how to call to connect.

Um, roads to recovery is also gonna be a part of that um presentation so that we can start at the business level to try to get them in the right door, and then we can start this process as well.

So it's kind of a pilot with Broadway merchants.

Um, I will say we do have constant conversations with Baker and Lama.

We're presenting, they do bring us um initial issues, but I think when we did talk to folks, we don't discharge people in scrubs if they're discharged correctly, and so that's one thing that that is a flag for folks, right?

Um, is that Denver Health didn't discharge.

They may have left on their own, and so maybe that's why you need to call the mobile crisis unit or you need to call STAR for that type of response.

So we're working closely.

I think as these um programs build out, we'll get a better model of how to go into some of these neighborhoods that are really struggling to give them the resources to connect these individuals in the right space.

Okay, thank you, Stephanie.

Thank you, Mr.

Chair.

Thank you, uh, Councilmember Torres.

Councilmember Cashman.

Thank you, Mr.

Chair.

Thanks for the presentation.

Thanks for the good work on a related um topic.

Uh over the years, several times, uh, Dr.

Thurston had told me that the Denver Health had numbers I'm remembering, 20 or 30 psychiatric beds that couldn't be used because it didn't have the psychiatric nurses available to staff then.

What's what's up with all that now?

So that's actually going to be a part two of the presentation, but I can give you a brief look.

I'll give you a teaser, Councilman Cashman.

So the beds that Dr.

Thurston was talking about is there was 42 adult and 21 adolescent.

And then now the expansion is 12 that we'll have open in November that that we've utilize the 2Q dollars.

Oh, Donna, sorry.

Well, am I allowed to speak?

Yeah, you have to come to the mic.

I know I love this question because you always ask it, and now I have a really good answer.

So Denver Health has I'm sorry, sorry, CEO.

Yes, sir.

Excuse me, sir.

Yes.

Donna Lynn, CEO of Denver Health.

So Denver Health has 78 inpatient psychiatric beds.

There's lit between 57 of them are for adults and 21 are for children.

And when I've come previously, or Dr.

Thurston, we would say we can keep open about 50 because we lose money on every single bed.

So even when we keep open 50, we're losing money.

So with 2Q, we've been able to open up, so we've gone from 50 to what's the sum of 42 and the other number now?

50-4.

54.

And then we have 10 new inpatient psychiatric.

Well, they're a combination of medical and psychiatric bids that are coming in.

And we have had so the bids, the good news, I'm sorry to do this ahead of the two Q, but we will be fully open in terms of our psych bids, irrespective of cost, because we will use some of the two Q money to be able to either hire internally the inpatient psychiatric nurses or where we have to go out sometimes to contract and pay them a higher rate.

So staffing is generally available at this point.

Staffing is if you pay for it, you can get you can get it.

And we're but we're not finding the problems that certainly immediately post-COVID, we found.

That's right.

No, it's not of that.

Thank you.

Thank you, Mr.

Chairman.

Uh thank you, uh, Councilmember Cashman with uh tying in both of our briefings into one.

So I have uh two questions.

I uh and actually we look around the room, make sure no other questions, and I know we don't have any questions online.

I highly scrutinize the Colorado Coalition for Homeless um contract that came through with DDPHE for providing um health services to um folks in all in mile high um uh um spaces.

And one of my concerns were the lack of outcomes from data.

Um as I sit and I listen to the data and the collaboration that you have, my curiosity is what is your understanding of kind of your data sharing for all in mile high services provided by Colorado Coalition for the homeless on the contract they are receiving from the referral process that that's tied into that.

Can you speak through how that data is being shared, how it's being uh maybe used within HMIS or MDHI, um help me with connecting those dots, and I think that'll be helpful for folks to have a deeper understanding of that.

Um I will I will start and then maybe um Stephanie um or others on my team can um jump in.

Um, so um, you know, we've been working with the coalition since 2018 to improve data sharing.

So we actually have integrated data to tell us if in our electronic medical record, which is epic, um we can see not only if Denver, if a patient has a medical home at Denver Health, but whether they have a medical home of the Colorado Coalition for the Homeless, and that comes from Medicaid attribution data.

We have a data use agreement as well that has been executed between our organizations to be able to more easily share data on some of these projects, including the recruitative care center.

We're helping with an evaluation of that that the coalition is doing, but we are sharing data for understanding the impact on health care utilization and costs.

And so the all-in-mile high sites, I think, have been challenging for a lot of reasons because we don't, we were not always able to identify whether someone is at an all-in-mile high site.

We have a much easier time now that we are accessing HMIS on more of these patients.

However, we have a small team, we're not touching, we can't see all 300 patients that are experiencing homelessness a month that get admitted to our hospital.

But for the subset that are that we're getting consulted on that our team is involved with and looking up in HMIS, I do think we have better visibility of who is in all in mile high and who to coordinate with.

And we've also worked with host through the complex case team as well as through Aaron's team to get in contact with the case managers that are in the all in mile high site, whether or not that's the coalition, or maybe that's another agency, and we are doing that.

I would say that is also more nascent work and challenging sometimes.

Do you anticipate having additional folks with Denver Health that have access to HMIS?

I believe there was a wasn't there a certain number of folks that have access.

Can you share a little bit about that?

Because I it's extremely important.

You've provided in this presentation an end-to-end view of touches from folks on the street to folks being referred to you to folks receiving um care throughout their whatever their situation was that they hit you to housing.

That is extraordinary.

You have a dashboard.

So having HMIS access, I would assume would be very helpful.

So can you provide some caller on how many folks have HMIS access?

On the inpatient side, no one had access before we received this funding.

And so there are there's a hand, a small handful of us that do.

There are also some teams in our behavior outpatient behavioral health uh setting as well as our ambulatory care who do also have access specific social workers and case managers.

However, it's um, you know, whenever you have a system that is you know we have our electronic medical record, and then we have to log into this other system.

It's a housing system, it is not a substitute ultimately for what Colorado and our region really needs, which is a social health information exchange.

Okay, um, however, I think we are learning lessons that can help us understand um, you know, what's the right um, who are the right people to have access, how do we use this?

What are the workflows once we identify someone?

Our team is at the forefront of trying to better understand that, which will inform we've been we've had some interaction with the the COSHIM work through the governor's office, which is slow work, but very important work, particularly for this community.

I think a deeper discussion on this um will be necessary.

So the good thing is uh we'll be inviting you back uh to the committee, and I think this is an important uh dialogue, how we're sharing information and how we're sharing sharing outcomes based on the amount of dollars we're spending.

My final question, you don't have to answer.

My hope is for you to bring this back.

There was no migration or my um data demonstrated for folks who are providing support for um that are outside of city and county of Denver.

Um would love to see if you have any way of tracking that level of support through this process that we're determining because obviously we are um the the the um the hospital for quite frankly this the state for folks who are needing um health and support.

So I would love to know if um in a future time when you come back, do you have data on how many of these um residents you're providing support for that actually may have resided outside of Denver and um had instances where they were transferred to Denver Health and we're providing services or providing housing would be very helpful.

Thank you.

Once again, uh one more look around, C Baron.

You got a questions for folks?

Thank you all.

I have one comment, Councilman Watson.

Um, these folks and and Aaron from Roads Recovery, I think they have really built a successful model that we should continue to look at as we're talking about permanent housing and what threshold we need to continue to care for these folks.

So I think as conversations go down the road, we we have a very successful model that we should be utilizing to councilman Torres's point, right?

Like it is working the way that we're looking at individuals, and we have a relationship with them that can then build a rapport with roads or the vice versa, right?

And so I think this also works for all in mile high.

And Dr.

Stella and her team didn't give enough credit.

Um, host is actually asked them to come and sit down and talk through this model as well to really figure out how do we now take it to the next step, right?

We we have a good success with roads.

Now, how do we move it on to the next um conversation?

So maybe that's the next we bring that in is to talk about you know how do we formulate and then always looking at the dollar amount, right?

It's it's we can make this be successful if we can put all of our resources together.

Well, we're in budget season.

I think it's important, Stephanie.

I know you are gonna miss the opportunity to share the opportunity for us to support.

This is working.

I love the data.

Thank you all for the work that you're doing.

Um, and thanks for coming and presenting at Health and Safety.

Thank you.

We'll transition to the uh next presentation.

It is uh Denver Health 2Q, sales tax spending plan.

We have the amazing Donna Lynn, CEO of Denver Health.

How do I give it?

Elise, DDPHE, and others.

Uh, then we'll give you some time to transition for the next presentation.

We have about 45 more minutes, so maybe 30 minutes of present, 15 minutes of questions.

Um that many.

And um thank you, council members and council.

Councilman Watson in your new role.

Um, just a couple of follow-ups on the prior presentation.

Um, just I'll put an exclamation point on what we're doing, does by no means meet the need that we see.

So we're not successful in transitioning every person that comes into us who's homeless or facing housing insecurity into one of those two locations.

Um, while we did get a DDPHE grant, um, this also doesn't support the full range of the activities that we do.

The Colorado Health Foundation actually did give us a small grant.

Um, and when Dr.

Sella said there was eight million dollars in avoided um expense, that doesn't mean that's revenue that comes to us.

In other words, people were staying too long in the beds.

If we have the opportunity to replace them in those beds with paying patients, that's a good thing.

As you know, many of our patients are not paying patients, so um, but you can see the work that they're doing as a team is essential to the city, and we're really proud to be able to do that work.

So, um, I do want to say one thing before we start.

Thank you first of all for the opportunity to be here and talk about 2Q.

Um, we have been importantly, because I think this will be a question.

The city has been really great in terms of transmitting uh the two Q money to us.

So we get that on a regular basis, and that has happened um pretty much since February, early March, where we got some catch up, and now we do get that on a regular basis from them.

So just to refresh, our ballot initiative, which was November 5th of 2024, asked the voters should um the sales tax be increased by 0.34 percent and devoted to five areas, and I'm gonna spend uh part of my presentation talking about that, but I want to lay some context because the number of uninsured patients, and therefore patients that we see at Denver Health who live in the city and county of Denver has been going up tremendously.

So I'll start with that, talk about 2Q, and then round it out with what we know is about to happen to many services in the city, the state, and the country, and that is the result of the bill that President Trump signed on July 4th called HR 1.

So there's some foreboding on the horizon that you can imagine, most of which will happen in 2027, but some that will happen as early as January of next year.

So our five areas.

Remember emergency and trauma care, primary medical care, mental health, drug and alcohol use recovery in pediatric care.

The next slide.

So as I said, to set the context, and you've seen this slide many times, this shows three things.

Just since 2017, it doesn't go all the way back to when Denver Health became an independent authority in 1997.

But it shows a dramatic escalation in the amount of what we call uncompensated care.

That's comprised of two things.

The number of patients that come to Denver Health who are completely uninsured, and the number that come with expenses from Medicaid predominantly, where the federal government and the state's government reimbursement is less than.

I like to say if you need a dollar to provide the care, and it's apropos Councilman Cashman's question.

If you need a dollar, if your reimbursement is only 85 cents, you've got to figure out where to get the remainder of it.

And that's roughly what Medicaid and Medicare provide to Denver Health.

And it's hence why a lot of other hospital systems are chasing what we call commercial pay or somebody with a United Healthcare, Aetna or Cigna insurance card.

We do not get a significant portion of those patients, and I'll show that to you in a minute.

So the real concern came post COVID, and it's a combination of several things.

More patients coming to Denver Health, and health care expenses skyrocketing post-COVID, predominantly in wages, but not exclusively.

As Councilman Cashman says, and I'm still I'm working on some more information for you on this out-of-county group of people, we began to see that a lot of patients were coming from outside of Denver, particularly Adams Arapaho and Jefferson County.

And in 2023, we put a halt to that.

We on a volunteer for those people who are coming for what we call elective procedures.

By law, you cannot turn somebody away in the emergency room, whether they're from England or they're from Alamosa.

So what we saw though was there were a lot of patients outside of Denver who were coming for primary care, preventive care, and we actually stopped providing that care in 2023.

Part of that was our conversations with the council and with the mayor and our own recognition that we can't just have an open door, and that there are hospitals and healthcare systems in those counties and throughout the state that ought to be taking care of those patients.

So you can see that the so that to go through the three bars, the 30, almost 31 million is the subsidy or the support we call medically indigent payment that comes from the city.

It's been constant, it has not increased due to increases in cost inflation, etc.

So that number has been static, and I'm not gonna, I'll add two Q in a moment.

The bulk of the uncompensated care that we get comes from city residents, so about a hundred and ten million dollars in 2024.

And then we do have about 36 million that comes from outside of the city and county of Denver.

Again, some of which is unavoidable.

We can't turn somebody away that's on vacation here that's driving on Sixth Avenue to go to a Broncos game.

But if you look at the lines, you can see that it has leveled off substantially, and we're continuing to try to do that work.

And of course, we have gone to the state of Colorado, and for the last three years, the state has given us five million, then six million, then five million over those three years to offset the cost of that 36 million.

Not the full amount, obviously, but still a little bit of a down payment.

We can go to the next slide.

In healthcare, we often talk about what's known as payer mix.

So that is the split between Medicare, Medicaid, commercial, and uninsured.

And 47% of our patients at Denver Health are on Medicaid.

Therefore, they have lower incomes and often come with many other what we call social determinants of health, and you heard the housing conversation.

They come with food insecurity, they come with transportation problems, and of course, housing insecurity.

So oftentimes the health state that they come to us in is complicated, often neglected and influenced by things like food problems, housing problems, et cetera.

About 20% of our patients are on Medicare, those are people age 65 and older, and a handful of people who are in kidney failure through end stage renal disease.

Our commercial population right now is 16%.

If you look statewide, the statewide numbers are more in the 30 to 35% range.

And a hospital like children's hospital, for example, is as high as about 46% commercial.

So again, we balance it.

It's as if you had a restaurant and you charge different amounts to different people.

You're dependent on the people you can charge a lot of money to to subsidize the lower paid people, and we simply don't have that luxury at Denver Health because of that huge piece of Medicaid, complemented by 10% of the population being uninsured.

So they have no coverage.

We do at Denver Health, you may be aware, we do try to enroll our patients.

We've been delegated by the city and county of Denver and the state to be an enrollment site.

So we enroll people who come to Denver Health and say, I don't have insurance, but I need health care.

It could be in the emergency room, they could be in an inpatient setting, they could be in our clinics, and we try to enroll them.

Every one of our 10 clinics has an enrollment specialist on site.

We have 80 people in total at Denver Health who do nothing but try to enroll patients in applicable payer sources.

And patients are free to say, I don't want to fill out the paperwork.

We try to encourage them, but we cannot compel them to do that.

So 10% of 10% of our patients are completely uninsured.

You can go to the next slide.

I want to show you the city and county of Denver numbers just for the last few years.

And it's pretty striking if you look at the difference between 22, 23, and 24.

So we are seeing dramatic increases in the number of patients who have Denver res Denver addresses, excuse me, who are uninsured.

So that Denver Health sees about 280,000 patients a year.

80,000 of them live in Denver and have no insurance.

They can make a choice not to take insurance even if they're employed, but in some cases it's employers, think of Uber, that don't offer health insurance.

They're not a traditional employer.

So this is very concerning to us.

We have not even seen the effects of HR1, and we're seeing a doubling of the number of uninsured patients in Denver just over two years.

You can go to the next slide.

So we haven't quite seen a doubling in terms of the number of visits, but we wanted to be transparent about how frequently these patients come in to us.

There are some migrant numbers that are embedded in here.

The mayor actually asked me this question maybe a month or so ago, and it turns out that less than 10%, about 10% of our uninsured patients that we saw in 2024 were in the newcomers slash migrant category.

Okay.

So let's talk about 2Q.

Remember the five buckets.

So emergency and trauma care is a place where actually most of a good percentage of the two Q money will be spent.

It is a very large department and division.

It includes our paramedics and it includes the physicians and the staff that work both in emergency management in the ER.

We have over 700 employees in that space.

And again, think about how the uncompensated oftentimes come into Denver Health.

It is often through that emergency room.

So 2Q will allow us to devote about 36 million dollars to our emergency and trauma care.

And I'm going to get into at the end of this some of the other expansions.

We are hiring some more advanced practice providers in our clinical decision unit where we make decisions about where patients actually can move.

You can go to the next slide.

Primary care was the second area.

We spend about 85 million dollars in primary care with about 600 of our employees in that area.

We are estimating that our 2Q spend will be about 16 million in this space, and you can see on the right hand side a number of the expansions.

We have four mobile units at Denver Health.

Two of them are, we live on grant funding to keep them going.

And so the 2Q money will allow a more sustainable funding source for our mobile units.

And I might have to ask councilwoman Diana Romero Campbell for help with these intransigent landlords.

Anyway, we hope to have that open by the end of the year to serve an area where we currently have no clinic.

So that will be our 11th clinic in our system.

You can go to the next slide.

Pediatric care was the third category.

This is our inpatient, the dollars here reflected our inpatient pediatric expenses and staff.

We do have an inpatient unit.

We have an inpatient pediatric emergency room that I think some of you are aware of.

You can see some of the volumes, and there are some expansions that have already taken place in terms of in particular in our school boat school-based areas, we are beginning to do more and more virtual urgent care on your phone, which is a way that I had my own appointment at 7 a.m.

on a Sunday morning, for example, and it was an easy way for me to take care of something that was didn't require me to travel into Denver Health.

We also have a foster care program that allows us to aggregate the medical records for young people who are on foster care and provide that to parents as the foster care home switches.

You can go to the next slide.

So mental health and sub mental, let's do mental health and then talk about uh substance abuse.

Our budget here is about 60 million dollars.

This includes a separate psychiatric emergency room as well as the inpatient services and outpatient services.

So we have mental health as Councilman Cashman asked, and I'll go into this in more detail in the next slide.

Those inpatient beds, we have outpatient services throughout all of our community clinics, and then that psych ER, which is quite a busy and active ER.

We've attributed about 14 million dollars to our spending in this area, and it's almost exclusively those two, those 12 new beds, and I'll do the addition on the next slide.

So those will open up.

It's been a long process of getting regulatory approval, but we will be open in November to begin taking patients who come in with a medical condition as well as a psychiatric.

You can go to the next slide.

Oh, you're kind, thank you so much.

Okay, so alcohol and substance use treatment.

We have allocated about 2 million in this space.

Can we go back?

I think the slide is wrong.

So I want to make sure we have the.

Oh, you might not have the fresh one.

This is the ones up there.

Oh, perfect.

That's the one I need.

Thank you.

So to do the math, so I said we had 78 beds.

We were keeping last year 50 of them open.

We now have 63 of them open.

And then we will open 10 more in November.

So we are pretty much close because the medsite beds required a little bit of space, we're not at the full 78, but we are, you know, within a handful of those.

So we're going from 50 to 63 to 73 inpatient beds.

And we frequently turn people away.

We don't know what happens to what happens to them.

We do do referrals to other private facilities.

But our feeling is, as you heard, Dr.

Stella, we often have the person's medical record for a long period of time.

It's much better to stay at Denver Health and get the complement of medical services and psychiatric services.

So in mental health, that is our primary expansion is to both increase the beds, which we've already done for this year in the more traditional format, and then go to the medsite beds.

And then the last thing is our alcohol and substance use programs.

We have allocated just about $2 million of our 2Q spend in this area.

You can go to the next slide.

Now, just a reminder, 2Q money has to be spent, it can't be spent on capital.

Hence we are part of the vibrant Denver bond.

So thank you for your support in doing that.

The 20 million dollars and that ballot measure will allow us to be building part of the West Side Clinic, the Sam Sando's Clinic.

We Denver Health is putting in about $90 million of the expense related to that, both through philanthropy and our own private financing.

But there are a small number of things that we've also been able to do in terms of new purchases, including remounting some of our ambulances, buying equipment for our emergency department and for our paramedics.

Go to the next slide.

Alright, so that's the end of my middle, I'm calling it my sandwich, the middle of the sandwich here.

The other side is what's coming.

And I think you're probably well aware, but I want to translate it to what it's going to mean to Denver Health.

First of all, in May of 2023, remember during COVID, you could stay on Medicaid and not have to recertify.

So the public health emergency ended in May of 2023, and that meant that a substantial number of people in Colorado lost their Medicaid coverage.

The projections for HR1's impact because the recertification process goes from once a year to twice a year, is that we will lose anywhere from 200 to 300,000 more people.

Obviously, Denver Health, as a provider of Medicaid services to a substantial number of people, could be faced with 20 to 30,000 more people who had Medicaid, who undoubtedly are still familiar with Denver Health and will come back to Denver Health.

So we're anticipating in 2027 the beginning of a wave of more people who are uninsured.

As you know, the state goes into its special session tomorrow.

There are probably the most immediate thing that is going to happen in January of 26 is that our current exchange where people buy insurance will lose subsidies.

And the state's trying to fix that.

That is part of HR1 as well.

And if that happens, we will lose, it's hard to crystal ball it, but we know the state is estimating there might be a hundred to a hundred and fifty thousand people that will drop off of the state exchange.

So these are people who are not eligible for Medicaid.

Their employer doesn't provide insurance, and they can go into what's called Connect for Health Colorado that allows them to buy insurance coverage.

So we have the state to worry about, and of course, this is going to create a big problem for us.

Omni Salute and Cover All Colorens are two programs that we're very concerned about.

Those are programs that provide health care for various categories of undocumented individuals.

Denver Health has 800 omnisalude patients that come to us each year, and cover all colorens that went into effect on January 1st provides coverage in Denver Health for 3,000 people.

So because of the federal government's insistence that people who are undocumented are not eligible for any programs via Medicaid, we are facing, perhaps, depending on how they choose to enforce this because this is executive order regulations, who knows what.

We could lose 4,000 patients who right now we are able to get premium and payment for, but could potentially fall off of the coverage rolls.

So lots of big impacts.

Our overall estimate of impact on Denver Health.

This was made by a third party organization called Third Wave, is that we will be short 64 million dollars a year.

It's an interesting number given that 2Q gave us 65 to cover what we were already in deficit for.

These are the major provisions that you are probably familiar with.

As I said, we but also counties determine whether or not people are eligible for Medicaid.

We do everything we can to make sure that someone who is eligible gets their Medicaid.

But a new rule will be work requirements.

This is as of January 27.

We will be working with the state to try to determine how we collect the information.

I think you've seen there's only two states that implemented work requirements in the past, and they were very clunky systems.

So we will have to be validating whether or not someone is working the requisite number of hours, which is 80.

As I mentioned, that recertification process now goes from annual to twice a year.

That means we will have to add staff to be able to take people cycling through just that process.

And then right now, if you come into Denver Health or any other hospital on January 1st, we determine you're eligible for Medicaid.

There's a lot of paperwork.

We process it.

The state processes it, it comes back.

We're allowed now to look back and say, hopefully that gets processed in 90 days.

We can get paid up for that January 1st admission.

That look back period now has been shortened to 30 days, which is going to be a major lift for both Denver Health as well as the counties and the state.

And then I mentioned the no federal funding for the undocumented.

There's some more complex things that happen in 2028 where some of the supplemental money we get for Medicaid will also be reduced.

And with that, that is my sorry.

That's my conclusion.

Go ahead.

Thanks.

I'll introduce myself, take the time because I know you have many questions.

I will be very brief because I know you have more questions.

This the intention of this slide is to provide our the city's mid-year spending plan update.

Originally, I believe it was in May.

Megan Prezzo from the department had shared our, we can, according to the contract, we can spend up to 1% for the city's administrative costs, which would have been about 640,000.

We'll obviously not spend that this year.

So maybe the small drop in the bucket good news would be that we anticipate by the end of this year probably spending about 246,000, which means anything above and beyond that would go back to Denver Health in the annual reconciliation process.

So a small portion of good news.

Okay news.

And just wanted to point out that this covers my salary, and I just started a couple of weeks ago, so that's some of the salary savings.

A fiscal administrator who will help with the contract and the invoicing process so that we can get payments quickly on time, a portion of our leadership's time leading up to me getting hired and the negotiation of a contract and setup of the fund, which was pretty intensive on our side.

Some funds that we don't anticipate being able to spend all of them for professional development, things like that.

And then well, you all in city council will see a contract for a financial services consultant who will help us with some of these administrative uh oversight functions.

So that will we will be executing the contract by the end of this year, and I'll ramp up in next year.

So we won't be spending the full 1% this year is the main takeaway.

So thank you for letting me take the time, and I'm sure you all have more questions and comments, but thanks so much, Elise, and welcome.

I know you've been here, but welcome to Denver Health.

We're looking forward to hearing more from you on the work that you're doing.

Thank you, CEO Lynn.

Thank you, Stephanie and team.

We do have a queue of city council members starting first with council member Torres and Councilmember Flynn and then Council President Senville.

Thank you, Mr.

Chair.

Thanks everyone.

Um just kind of um uh overarching question.

It I was looking back through when uh we did the work in March to set up the funds and stuff for this.

Um it was still kind of a um a big window of between 60 and 70 million that's anticipated um this year.

Do are we do we have a more narrow number that we're that we're projecting?

Yes, we do.

Um so we are receiving 64, I think the number is 64 million.

64.7 was the latest uh projection I heard.

We are get so what we are getting paid is what each month one twelfth of 64 million.

Just like with caring for Denver, there's a reconciliation process at the end of the year.

So it could be that we owe money back because the sales tax revenue has not been what we thought was good.

So if it's not 64, um, there's a reconciliation.

Yes, the numbers in the slides are more than that.

So what happened is when we submitted the original spending plan that was approved, it had the 70.4 in it, and so we didn't want to go in and change any of those numbers just yet because we presented on the 70 through the original spending plan, and then next year when it comes through, we'll have a better understanding of exactly what dollar amount um to put within those buckets.

Do you know now where about six million will be drawn out from?

Well, where we'll be drawn out from, but basically our losses.

You know, our losses will be greater or revenue will be less based on we'll continue to provide the services, but it's not as though there's any takeaway in terms of reductions.

So that's something that I think might be helpful for me to better understand.

Because my next question is just about like metrics, what do we expect to see and then be able to share with the public as a result of Denver Health receiving this funding?

One, because I think the slides are really helpful.

It's it's more important for me to understand the difference that these dollars are making in what might otherwise be seen as cuts or uh limitations in availability or access.

So I'll use the site beds as an example, I think is a great one.

If if that can be a much um more visual, visual and tracked, if that's what's changing because of the dollars, I think that's amazing.

I want to be able to point to that and see how that changes over time.

Um, if it's just like we're filling a hole in the ground, a budgetary hole, that's more difficult to say here's what a difference the 64 million is making.

So just want to understand I think how we might see data in future reports.

Sure.

And we did give, I think in the March presentation.

There, so we've been working on, you know, how do we measure things?

Number of additional patients, you know, other kinds of outcomes.

And I think we gave that in.

We did in the spending plan, and I think we tried to bring in some of the metrics that are in the spending plan, like volumes or visits.

I think what we're working on from a team, because we're building this as we go, right?

Um, is I think the piece that we need to put together is how we show from a medical perspective to the community the impact on the puzzles, right?

Dr.

Federico explains it really well about uh FTEs and patient teams, right?

Like without two Q dollars, we can't hire five more FTEs to have hours at the Montbello clinic, right?

And so I think we'll have to figure out internally how we break that down to a more elementary mathematical equation that makes sense to the public because all of those expansions that Donna talked about, we wouldn't have been able to expand without those.

So I think it's now going back and breaking down those a little bit more to say, okay, this is the impact and this is what happened with those funds, and we're not closing clinics, right?

So we expanded hours at the pharmacy and lowry on Saturday, right?

Like because of 2Q, we're able to have those additional hours and we can add that cost and see how it does.

But I will tell you, this is a learning um we we want your feedback as to what you think will be interpreted well, um, because we do come from a hospital position, and so sometimes volumes and patient visits is the language they speak, but it doesn't translate well.

Um, and I think we want to show all these exciting things that we're doing.

Um, and that's what we also put the slide of because of two Q, right?

If we hadn't had two Q dollars, we wouldn't have been remounting uh ambulances, right?

Those priorities of those small things on the ground we couldn't afford, but now we're able to actually cross some of those things off of the list.

That would be super helpful to be able to see um more of that direct impact and where the dollars are going, even if it changes from year to year, right?

Um but I think that would be really helpful for me.

But I really appreciate it, and thank you for uh for the mid-year update.

Thank you.

Yeah, thank you, Mr.

Chair.

Thank you so much.

Uh, Councilmember Flynn.

Mr.

Chair, follow up on that a little bit.

Um, but my first question is on the slide of the pie chart.

I'm obsessed with pie charts today.

I must be hungry.

Uh on the pie chart on slide four.

Is it possible to show within that chart?

Those are your payers.

Now, two q is also an influx of revenue through the tax fund to show how uh the two q funds filter through those various categories.

The patients who are represented by uninsured commercial Medicaid Medicare, how's the two Q money uh being used within relation to those payer segments?

Is that a possibility?

Yeah, I'm looking, I'm looking at my CFO and many other people are here from Denver Health.

Um so April, this is April O'Dane, who's our CFO.

Maybe you could come to the mic.

Uh obviously it's not going to filter.

We're not doing any, well, I shouldn't say we're not doing anything for commercial patients.

I mean, if we remount an ambulance, there's a chance that a you know a commercial patient comes in that ambulance.

Well, just give me a bit of a picture of how it's impacting those areas of payers.

Um particularly the Medicaid, which is quite risky.

April, if you don't mind introducing yourself.

Okay.

Hi, good morning everybody.

I'm Evil La Day, CFO for Denver Health.

Um, I think it's going to be difficult for us to take those 64 million and translate it to each.

But let me think about how we might be able to do it because it's not like we're getting a payment for a patient to cover that gap.

And so that may be a little difficult for us to track, but I think we have a way we can show some things about that.

Okay, thank you.

Yeah, so Steve Federico, Chief of Government Affairs at Denver Health.

Um, maybe I can marry both comments.

Um, Councilwoman Torres and Councilman Plynn.

Um the way that the way that we build a program at Denver Health, for example, we'll hire a pediatrician, we'll hire a part, every pediatrician needs a little piece of a nursing clinic.

We need a medical assistant, we need a clerical staff.

We call that a clinical team in our primary care.

If that team works five days a week, we can say they're gonna see X number of patients, roughly say a hundred patients in a week.

So we could break it down potentially, but here's where it gets complicated.

We can give you the cost of that team for a given year and an estimated number of patients they would see in a given year.

Breaking that down though for two Q gets complicated because they may see a Medicaid patient, they maybe see a commercial patient, they may see an uninsured patient.

So we could do that.

This is a two-cute position, but then who knows who they see when they see them and how does that break down?

So it's easier for us to do it in the context of the patient volumes that we've seen by area, which is what you saw broken down here.

100,000 visits in the emergency department costs this much money.

We're allocating 40 million dollars in the emergency department for all of those visits because the uncompensated care in that area was so big.

If we didn't have two Q, which would was your question, we would have five fewer teams in the emergency department.

So we'd have five percent less volume, for example.

So that's sort of the circular discussion, right?

And so that's what we'll try and try and put that away.

That is both very transparent but very understandable as well.

We'll do our best.

But the pie chart would be more difficult, I think.

Thank you.

If you ever figure it out, could you come over and explain why explanation of benefits forms like that?

No, never mind.

Or help me fix your BHS.

No, no, I'm not and Councilmember, I just want to make sure folks are aware we have eight more minutes.

Yeah, but for folks, thank you.

Um is there uh an actual document, the addendum to the agreement that we can actually read in addition to this presentation that encapsulates it because what I'm looking for items like uh not just patient volumes but patient demographics and quality metrics uh outcomes, for instance, of all the spending.

Excuse me.

Yep.

Is that part of the addendum?

And could you forward that document to us?

So that is what we've proposed.

Here's we're literally building the plane while we're flying it this in August.

That's not good.

But at the end of the year, just like we give you the annual report to the city on the city purchase of services like the jails and the paramedics at the airport.

We will be giving this the council and the mayor a similar document that has those kind of metrics in it, but right now we're just in flight, and so some of the numbers like the psych um the additional medsite beds, are in 2026, are gonna look very different than they are this year because we couldn't get it going until November, but you will get that.

Because I thought there would be a printed document also with uh with all these metrics spelled out.

Why don't we do that?

For the mid-year for the August report that's in the agreement.

I think it's just a so the demographics is a piece that um our legal team is not comfortable releasing publicly right now just because of something some stuff that's happening in the federal government.

I think once we get kind of through some of those hurdles, we'll know better what what we can and can't put out publicly.

Um, some of those metrics are in this presentation, we just need to mirror them against the spending plan.

So, what I can do is I can take the metrics that we put into this PowerPoint and go update the spending plan and give you a half year review.

Will that help?

Um, it could.

I'm particularly interested in the quality metrics.

Okay, cool.

Yeah, we we can definitely, uh thank you, Council Member Flynn.

Council President Sandoval.

Thank you.

Um, thank you for all the great work you do.

Um, and I'm thankful to see the money come out.

I also just I won't be laboring questions because a lot of my colleagues asked what I wanted to what I would ask him for.

Um, oftentimes when we get these, even though it's the first year, and I know that it was we had to get to the first quarter first late and almost to the second team and get you the checks, right?

So we were paying like it's been super complicated to set this all up.

Um the one thing that usually comes with um these tax dollars, these special tax, like sales tax dollars, is more of an in-depth report because to council mentoris, councilman flint, it's something that we want to share out, and it's something that um I've just been looking at for a while now since on council, referring these sales tax measures, and making sure that they have language in the contract that is clearly identifiable so that we can have go back and say we vote on these contracts, and so this is the information that you all need, right?

Because it's it's tax dollars, sales tax dollars, so just want you to know that it's not just you that we're asking these from.

This is every sales tax initiative that has come through, and even one of them, we as you all know, or may not know.

We came for Gembly, we caring for Denver Lee will be usually a one-year contract because we were concerned with some of the things language in that contract, because that's what this body votes on is the language within the contract, and in that language within the contract is what holds you all to um a form of reporting back out to us so that we can share that out to the public.

So I know it's beginning towards the end of the year, but Mr.

Chair, if you could have them come back, I feel like it's important even in December or sometime in the fall, Christmas, whatever last quarter, I will just say, so that we can figure out how to, because I think setting, I'm always thinking about precedent setting, and I'm always thinking about what happens in the first year.

Kind of say lays the foundation for how things move forward, and I wouldn't want this presentation.

I think we can figure out a more robust um tool to share out publicly that this will I don't want this to be the foundation that we set everything on.

I think we want to make sure that we understand this year was complicated, we rolled it out, and it got complicated because we have a president who is ideologies are absolutely um opposite of what we have in here in Denver.

We are investing in our people getting people off the streets and into housing.

We are investing in a housing first model, we're investing in wraparound services.

That's why this committee is health and safety, right?

Right now, because it's two identical metrics that go hand in hand, like the last one presentations maybe that this work is supposed to be doing, which is the social impact on work that we're doing, how the thousand work that we're doing rosary, right?

The whole labor, but reporting out on sales tax measures is just so important um to the public because we're the body that is the only body that can refer something even to the public, so we just have to be able to hold that a little bit standard a little bit higher.

So I think a good time would be we're coming back with the operating agreement, and we usually come back um mid-October, so maybe we could double down and we can do the operating agreement and then do a couple minutes after.

Let us go back and look at the volumes and all the data and then present to make sure that that's what you guys need for the end year report, since we are kind of building this as we're going.

Because I would hate to go down a road where we're creating all these metrics and it doesn't really kind of meet the needs that you have.

So if that sounds like a good plan, we can come back mid-October.

That works perfectly of um, and we'll be um working with us.

So thank you, Stephanie.

Thank you, Council President.

Thank you, Mr.

Chair.

That'll be very quick.

Yes, Councilman, so yeah, thank you.

Um, Mr.

Chair.

Uh, yeah, I just want to echo.

I think everything that everybody has asked for, and that we're talking about like that precedence setting and all of those things.

I want to agree to that, and also I think this is just another way that we're seeing how um DDPHE, you know, the city and Denver Health are working in collaboration with one another, and you know, coming up with those metrics, um, and then being able to then present those going forward, and so I do look forward to that.

So I just wanted to promote that and lift that up and appreciate um the words that council president said.

Thank you.

Thank you, Councilmember and Councilmember Pro Tem.

Um I'll do it in 15 seconds.

Um, thank you.

Thank you for just being so thorough and so thoughtful.

It's complex and and um entertaining all of the um detail that that I think we'd all like to see.

Um, what I would add is in an agreement is that there is a whole, um, I appreciate the buckets and the holistic approach to everyone across the city, um, and having that opportunity to think about that expansion as well, and serving um in Southeast Denver where there isn't a clinic yet a high need, and so I just wanted to thank you for that, and I'll end.

Thank you, Mr.

Chair.

Uh thank you.

Um Council President Pro Temp, thank you, CEO, thank you, Stephanie.

Thank you, Denver Health, DDP.

Oh, I think it's like a source.